April 2024 Update: Missouri Medicaid enrollment down nearly 200,000 since unwinding began
The number of children enrolled has dropped by almost 111,000 since June 2023, 56% of the drop in enrollment
May 2024 (updates based on April 2024 state administrative data).
As the process of unwinding (from the Public Health Emergency) continues, total net enrollment in Missouri’s Medicaid program continues to drop: down nearly 200,000 (down -197,525) to 1,319,166 from the enrollment level in June 2023 when the unwinding started (1,516,691). Thus enrollment has dropped -13% over the first ten months of the unwinding. These findings are based on analysis by CAHSPER at Washington University in St. Louis of state of Missouri Family Support Division data, posted on their website.
Factors affecting enrollment. During the Public Health Emergency (PHE) annual reverifications of Medicaid enrollment were paused by the federal government, which meant that those enrolled in Medicaid during that period were not disenrolled. Nationwide Medicaid enrollment rose to a record high during the pandemic, and in Missouri the enrollment also rose to over 1.5 million, a record. Federal law passed at the end of 2022 called for an end to the PHE, and a renewal of the recertification process, commonly called the “unwinding” of the pandemic as it is affecting Medicaid. The process of recertifying enrollment in Medicaid began again in June 2023, which generally had been done on an annual basis before the COVID pandemic. In addition the expansion of Medicaid began in 2021. Missouri residents continue to enroll in Medicaid through the expansion, or through other categories, or re-enrolled after losing their coverage (called churning). Thus the numbers reported her show the net effects of the unwinding plus new enrollees.
Total net enrollment. Net enrollment in Missouri’s Medicaid program has dropped to 1.32 million in April 2024, down -13% from from the peak enrollment hit right as the unwinding began in June 2023 (1.5 million).
Who is losing coverage? Looking at the drop in enrollment of 197,525 since the unwinding began, over half (56%) of the enrollees losing coverage are children (-110,938) (see graphs below). This is in part because children are a large share of the enrollees in Medicaid. But on the other hand the eligibility level of children for Medicaid is quite high (up to 300% of the federal poverty level), so it remains perplexing why so many children are losing coverage.
In looking at the other categories, roughly 16% each of those losing coverage has fallen into the categories of people with disabilities (-30,806) and custodial parents (-27,777), and 11% from the adult expansion group (-20,386).
Update on Medicaid expansion. As noted, the expansion of Medicaid began in Missouri in July 2021, with the first people enrolled in October 2021. As shown the graph, the current enrollment in the Adult Expansion Group (AEG) is 333,801 in April 2024. AEG enrollment fell in the first seven months of the unwinding, then rose for two months, perhaps suggesting there is some churning into the AEG. But AEG enrollment fell again in April 2024.
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Report prepared by analysts at Center for Advancing Health Services Policy and Economics Research (CAHSPER), Institute for Public Health (IPH), Washington University in St. Louis.